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Grantee Organization Information

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Name of Organization

Name on Articles of Incorporation

As listed on W-9 form

Employer Identification Number

Mailing Address

City

State

Zip Code

Preferred First Name of Person Authorized to Apply

Executive Director, CEO, Board Chair, or Lead Organizer

Last Name of Person Authorized to Apply

Executive Director, CEO, Board Chair, or Lead Organizer

Preferred Phone

Preferred Email

Is the contact person regarding this letter of inquiry different from the person authorized to apply?

YesNo

Preferred First Name

Last Name

Role

Preferred Phone

Preferred Email

Fiscal Sponsor Information

Will a fiscal sponsor be used for this project?

YesNo

Name of Organization

Name on Articles of Incorporation

As listed on W-9 form

Employer Identification Number (EIN)

Mailing Address

City

State

Zip Code

Preferred First Name of Person Authorized to Apply

Executive Director, CEO, Board Chair, or Lead Organizer

Last Name of Person Authorized to Apply

Executive Director, CEO, Board Chair, or Lead Organizer

Preferred Phone

Preferred Email

Project Information

What is the total project budget?

Whole numbers only. No commas or decimals.

How much is being requested from the Blandin Foundation for this project?

Whole numbers only. No commas or decimals.

What is the grantee organization's (or fiscal sponsor's) annual budget?

Whole numbers only. No commas or decimals.

Describe the grantee organization and its mission.

Provide a summary of the project which includes underserved populations represented, project activities, and geographic location.

Does the grantee organization (and the fiscal sponsor if applicable) adhere to Blandin Foundation's Anti Discrimination policy?

YesNo

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Contact Information